Prevalence and test characteristics of national health safety network ventilator-associated events
Authors
Lilly, Craig M.Landry, Karen
Sood, Rahul N.
Dunnington, Cheryl H.
Ellison, Richard T. III
Bagley, Peter H.
Baker, Stephen P.
Cody, Shawn
Irwin, Richard S.
UMass Chan Affiliations
Graduate School of NursingDepartment of Information Services
Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine
Department of Medicine, Division of Infectious Diseases and Immunology
Document Type
Journal ArticlePublication Date
2014-09-01Keywords
APACHEAcademic Medical Centers
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Patient Safety
Pneumonia, Ventilator-Associated
Prevalence
Prospective Studies
Public Health Surveillance
Quality Indicators, Health Care
Risk Factors
Allergy and Immunology
Critical Care
Infectious Disease
Pulmonology
Respiratory Tract Diseases
Metadata
Show full item recordAbstract
OBJECTIVES: The primary aim of the study was to measure the test characteristics of the National Health Safety Network ventilator-associated event/ventilator-associated condition constructs for detecting ventilator-associated pneumonia. Its secondary aims were to report the clinical features of patients with National Health Safety Network ventilator-associated event/ventilator-associated condition, measure costs of surveillance, and its susceptibility to manipulation. DESIGN: Prospective cohort study. SETTING: Two inpatient campuses of an academic medical center. PATIENTS: Eight thousand four hundred eight mechanically ventilated adults discharged from an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs detected less than a third of ventilator-associated pneumonia cases with a sensitivity of 0.325 and a positive predictive value of 0.07. Most National Health Safety Network ventilator-associated event/ventilator-associated condition cases (93%) did not have ventilator-associated pneumonia or other hospital-acquired complications; 71% met the definition for acute respiratory distress syndrome. Similarly, most patients with National Health Safety Network probable ventilator-associated pneumonia did not have ventilator-associated pneumonia because radiographic criteria were not met. National Health Safety Network ventilator-associated event/ventilator-associated condition rates were reduced 93% by an unsophisticated manipulation of ventilator management protocols. CONCLUSIONS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs failed to detect many patients who had ventilator-associated pneumonia, detected many cases that did not have a hospital complication, and were susceptible to manipulation. National Health Safety Network ventilator-associated event/ventilator-associated condition surveillance did not perform as well as ventilator-associated pneumonia surveillance and had several undesirable characteristics.Source
Crit Care Med. 2014 Sep;42(9):2019-28. doi: 10.1097/CCM.0000000000000396. Link to article on publisher's siteDOI
10.1097/CCM.0000000000000396Permanent Link to this Item
http://hdl.handle.net/20.500.14038/34989PubMed ID
24810522Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/CCM.0000000000000396